Raleigh Hand Center
3701 Wake Forest Rd
Raleigh, NC 27609
What is a radial head fracture?
Radial head fractures are common elbow injuries. They can occur from a variety of injuries ranging from a slip and fall at home to a major motor vehicle collision. The elbow joint is composed of three bones: the humerus, ulna, and radius. The radial head is the portion of the radius bone within the elbow joint. It normally contributes to the stability of the elbow joint and allows smooth flexion and extension of the elbow as well as forearm rotation (pronation/supination).
How is a radial head fracture diagnosed?
The diagnosis is made on the basis of history and physical exam. X-rays of the elbow confirm the diagnosis. Sometimes a CT scan is helpful to provide more detail about the fracture pattern. Occasionally x-rays of the wrist and forearm can help identify additional injuries.
What are the treatment options?
The treatment plan will depend on the severity of the fracture as noted on the x-rays and the patient’s medical condition, activity level, and desires. Most people have fractures which are stable and well-aligned, and, therefore, do not require surgery. Treatment in these cases is typically a brief period of rest followed by range of motion exercises. Follow-up x-rays are obtained in clinic to evaluate how the fracture is healing. Therapy is often directed at improving range of motion and strength during treatment. It may take several months for strength and range of motion to improve to maximal, even with therapy.
Some patients have fractures which are more severe, and the malaligned fracture fragments can create a mechanical block to elbow or forearm range of motion. Depending on the patient’s health and activity level, surgery may be advised to improve the alignment of the fracture and elbow joint. Some radial head fractures are seen in patients with elbow dislocations, which make treatment challenging and more prone to complications. For this reason, certain elbow fracture-dislocations are called "terrible triad" injuries (radial head fracture, coronoid fracture, and elbow dislocation).
The natural tendency of the elbow after an injury is to become “stiff.” A stiff elbow can limit daily function, such as grooming and reaching the face. In order to improve elbow range of motion, patients must be dedicated to their rehabilitation program, either with home exercises or physical therapy. This is true for both operative and non-operative patients. Specialized elbow braces can be prescribed if necessary to improve range of motion.
What is involved with surgery?
The surgery is usually performed on an outpatient basis using either regional anesthesia or general anesthesia. During the surgery I improve the alignment of the fracture and use an implant to stabilize the pieces. In most cases, I make an incision on the outside of the elbow and use low-profile screws to fix the bones internally. This is called “open reduction and internal fixation." Fluoroscopy x-ray is used during the surgery to assess the elbow stability, implant position, and fracture alignment.
Occasionally, the radial head is shattered or “comminuted” and cannot be put back together properly. The options in these cases are:
Each procedure has advantages and disadvantages. The decision will be made during surgery based on the patient's medical history and stability of the elbow noted intra-operatively.
What can I expect after surgery?
Rest and elevation of the limb to the level of the heart is very import for the first few days after surgery to reduce swelling. Shoulder and finger range of motion exercises are also important to help prevent stiffness in these joints.
After surgery, your elbow will be protected in a splint which will be removed in clinic after a few days. At this point, most patients should begin gentle elbow range of motion often with the oversight of a therapist. Strengthening of the elbow is not allowed until sufficient healing has occurred. I recommend avoiding heavy lifting, pulling, pushing or gripping for approximately 6 weeks after surgery.
Pain, swelling, and stiffness gradually improve over time. Most patients can return to more normal function at about 2-3 months post-operatively, but maximum improvement can take 12 months. Recovery time varies among patients, depending on the severity of the injury, possible complications, and pain tolerance of the patient. Occasionally, patients have residual stiffness and “aching” in the elbow after treatment. Arthritis, also known as degenerative joint disease, may develop in the future if the initial injury damaged the joint surface. My goal is to help each patient obtain the most function possible after the injury.
What can I do to improve my results?
Adequate nutrition is important during the healing and recovery process. I recommend a diet rich in protein and calcium and an adequate intake of calories per day while your body is healing. If you smoke, reducing or eliminating tobacco use will decrease your risk of nonunion, delayed healing, and infection. Complying with the therapist’s recommendations is very important to maximize your result.
How can I prevent this from happening again?
Some radial head fractures are related to reduced bone density or “osteoporosis”. Most people with osteoporosis can decrease their fracture risk with lifestyle changes and medication, and I will discuss this with you during your care.
What are the complications from surgery?
No surgery is risk-free. Possible complications include bleeding, infection, elbow stiffness, nonunion, malunion, arthritis, hardware failure, and damage to the surrounding nerves and blood vessels. The posterior interosseous nerve (PIN) is very close to the operative site. Injury to this nerve is uncommon but this complication can affect the function of the hand. Fortunately, most nerve complications are temporary, but some can be long-standing or permanent. A fracture which fails to unite is known as a nonunion. A fracture which heals with deformity is known as a malunion. Other complications are also possible but are uncommon. My goal is to avoid complications while helping people obtain the best possible result.
Copyright 2014 Erickson Hand Surgery
Raleigh Hand Center
3701 Wake Forest Rd
Raleigh, NC 27609